Chicago Tribune

Let’s play a quick game of word association. When we say: “U.S. Department of Veterans Affairs,” you say …

Many Americans would blurt: “scandal.”

Not wrong. Egregious example: revelations in 2014 of dangerously long wait times for veterans in need of medical care, some of whom died while on ever-lengthening waitlists. VA officials lied about — and attempted to cover up — those lists. More than 120 medical centers and clinics were flagged for a more extensive investigation into patient access and scheduling practices.

VA Secretary Eric Shinseki took the fall. But flash forward. Now, after major investigations and billions more spent, is the VA health system better? President Barack Obama says yes. “We’ve hired thousands more doctors, nurses, staff,” he told a recent conference of the Disabled American Veterans. “When we really put our sweat and tears and put our shoulder to the wheel, we can make things better.”

But for too many vets, Obama’s “better” is no good. Serious problems persist at the Veterans Health Administration, the VA’s medical wing. And they’ll continue until Congress and the White House commit to three goals:

• Allow more veterans to seek medical care with private doctors. The more flexibility in choosing providers, the better chance that veterans will get the excellent care they deserve.

• Streamline and downsize the rest of the system to focus on specialized care for battle-related injuries that private docs can’t perform as well as VA staffers.

• Fire workers who resist change or don’t perform.

A new report from the Commission on Care, created by Congress after the 2014 scandal, concludes: “Although VHA provides care that is in many ways comparable or better in clinical quality to that generally available in the private sector, it is inconsistent from facility to facility, and can be substantially compromised by problems with access, service, and poorly functioning operational systems and processes.”

Among the commission’s 18 recommendations for a sweeping overhaul: Create a more comprehensive and flexible “VHA care system.” That’s envisioned as a less rigid network of providers including doctors from the VA, military hospitals, other federally funded providers and facilities, and VA-credentialed private doctors and clinics.

The commission also suggests that the current Veterans Choice program be expanded so that all vets can consult private physicians. Good idea: It doesn’t take a specialist in battlefield wounds to prescribe blood pressure meds. In 2014, Congress passed Veterans Choice, which already allows many vets to choose a private doc outside the system if they live more than 40 miles from a VA facility or have to wait more than 30 days for an appointment.

Yet that law has led to billions of dollars in expenses, millions of square feet of new medical space … and even longer wait times at many VA facilities. One reason: The law not only mandated a complex new health system, but ordered the VA to set it up in 90 days.

Predictable result: bureaucratic chaos.

Predictable congressional solution: Let’s throw more money at the VA!

In the decade since 2006, the VA’s budget has soared from $73 billion to $167 billion, with much of the growth in the health system. Staff, too, has ballooned. None of that has significantly dented the VA’s entrenched culture that disdains accountability.

For instance: The 2014 law streamlined the process to fire VA executives who concealed the waiting-list scandal. Since then, however, only nine people have been fired for manipulating wait times, The New York Times reports. And some could get their jobs back after appeals. Maddening.

“If you don’t have accountability, and you know your job is safe whether you perform or not, it’s hard to make any progress,” Republican Sen. Johnny Isakson of Georgia tells the newspaper. “Right now, that is what we have at the VA.”

The Care Commission recommends a new board of directors accountable to the president. That could sharpen oversight or just provide more political theater and VA blamesmanship. The bottom line: No plan to revive the VA will succeed until superior performance is rewarded and poor performance is punished.

Until then, count on more VA scandals, more excuses — and more American veterans cheated of the care they deserve.